One of ThriveNYC’s biggest and most costly mental health initiatives was beset by confusion and mismanagement in its first 18 months, according to a dozen people hired to execute the program.

The Mental Health Service Corps was touted by First Lady Chirlane McCray, who spearheads the $1.2 billion Thrive program, as a means of deploying hundreds of new social workers and psychologists across underserved communities to administer to mental health needs where they are needed the most. It also promised the workers, many just out of graduate school, a unique chance to gain clinical hours toward their professional licenses while earning a paycheck.

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POLITICO conducted interviews with more than a dozen people involved in the program who described a culture of mismanagement that may haverendered the first iteration of the effort ineffective and hampered participants’ work toward eventually becoming licensed. Program workers were to provide free therapy to New Yorkers and screen for depression, anxiety and substance use disorder, according to the city’s description.

The workers, who were recent master’s-level graduates, told POLITICO they were poorly trained, their placements were slapdash and often needlessly onerous, and the data they collected under the city’s guidance was ineffective in tracking their success.

“It was almost like the AmeriCorp of psychologists, is what it felt like. That’s the way it was sold,” said one former service corps member who, like others interviewed by POLITICO, requested anonymity to avoid professional embarrassment and retaliation by the mayor’s office. “It was absolutely nothing like that. It was a lot of gaslighting.”

The messy rollout comes amid larger concerns about the effectiveness of McCray’s ThriveNYC program which she and the mayor have increasingly had to defend in recent weeks. McCray and Mayor Bill de Blasio have touted it as an unprecedented effort that is changing how New York City deals with mental health. POLITICO first reported in February that Thrive’s budgeting was opaque, and its metrics difficult to define. Since then, officials have revised how the program measures its effectiveness and sought to make its spending more transparent.

The program has stabilized somewhat since its rocky start, officials and participants say, but many in the inaugural class of the Mental Health Service Corps suggested it did more harm than good.

City officials admitted the program struggled with placements earlier on, but said it has since made efforts to improve the vetting of hires and where they are deployed.

“A natural part of the evolution of any major initiative is making adjustments along the way,” ThriveNYC Director Susan Herman — brought on in early February to manage the program — said in a written statement. “The Mental Health Service Corps is one of many programs we are taking a close look at as part of this evolution."

In its first year, the program hired roughly 125 clinicians, spending $16.5 million out of an $18 million budget in the fiscal year starting July 2016.

The service corps members were placed at facilities like community clinics, safety net hospitals and four-year CUNY schools. Three out of four sites were located in mental health professional shortage areas, according to City Hall.

The program offered salaries starting at $55,000 for social workers and $60,000 for psychologists, with supervisors earning $220,000 — all paid for with city dollars earmarked for Thrive. While the pay was competitive for non-licensed mental health professionals, the application process seemed less so.

“It sounded like the second I walked in the door I was hired,” said one social worker, who spent a year with the service corps. “I sat down, they asked me a few questions. And then at the end of the interview, they were like ‘OK, so just be looking out for an email from HR.’ And then they gave me a T-shirt.”

The city received more than 2,000 applications for a total of 159 planned spots within the Mental Health Service Corps, according to a program handbook.

Several former service corps members described the interview process as the first sign of trouble.

“You could have been placed to work at a primary care office or substance abuse facility or maybe a college counseling center, but there was no way they could guarantee where you would be placed,” one psychologist who participated in the program said. “In retrospect, that’s a terrible thing to agree to.”

The first group of service corps members began the program on July 5, 2016, according to the city. Participants said the training process was less than intensive and the placement process was slapdash.

“For two to three weeks, we were paid to sit there and just waste time. The training really sucked,” one participant said, comparing it to a high school AP course.

As complaints about training mounted, so did the pressure to move service corps members into the field.

One supervisor recalled Gary Belkin, now policy and strategy chief of Thrive, telling program officials: “I don’t care if they’re on their cell phones. They need to be placed.”

Asked for his reaction, Belkin declined to address the comment, but defended the program as one that has improved over time.

“The real story here is how we learned to get better at finally taking on a challenge the system had not before: getting behavioral health care where people have trouble getting it, such as primary care settings and our highest need neighborhoods, and training new clinicians," Belkin said in an emailed statement. "All our work was consistently focused on getting Corps members and partner sites what they needed. We were eager to find ways to share information and address logistical challenges to enhance efficiency.”

To fill some of the time before their placements, service corps members said they were trained in other Thrive initiatives, like how to administer the anti-overdose drug naloxone and mental health first aid — a beginner’s course for people with no clinical background.

“They trained us all for nothing,” said one social worker who spent about two years with the program.

The placement process dragged on for weeks.

The city claimed the sites had “been carefully selected” for need, cultural relevance and language skills. Former service corps members said the city simply placed clinicians where there was an opening and offered them the chance to swap with someone else.

“It was like they were throwing spaghetti at a wall and hoping that it sticks,” said one social worker who spent less than a year with the program.

The chaotic process led to haphazard placements that made a difficult job harder, participants said.

“People with certain language abilities were misplaced,” one social worker said. “People who spoke Mandarin were placed in Spanish places, while Spanish places had someone who didn’t speak Spanish at all.”

Only 48 of 111 clinicians who speak a second language were placed in facilities that requested a bilingual service corps member, according to Thrive metrics from Oct. 31 to Nov. 30, 2018. City Hall confirmed the program did not provide language assessments to place clinicians.

“We were hearing horror stories about people who were sent to sites that were not prepared for them or had no idea what to do with them or were in no way set up to let therapy happen,” said a psychologist who was still in training when the first wave of service corps members were deployed. “We’re all feeling vulnerable because we don’t even know what sites we’re supposed to be at after this pretty bad training.”

It took Thrive until Oct. 5, 2016 — or three months after the first group was hired — to place 110 service corps members, according to a city press release. The remaining members were either still awaiting placement or dropped out of the program, according to City Hall.

The problems didn’t end with the rocky rollout. Once clinicians were placed, some weren’t allowed to treat patients and others were put in untenable situations.

Often, that was due to billing practices, participants said. At the start of the program, service corps members and the clinics they worked for were not allowed to bill for services.

“The sites, once they realized that, they didn’t want to give any clients to the [service corps] therapists because they couldn’t bill for those hours,” a psychologist said. “That’s a room they’re giving an MHSC member that they’re not making money on. These are nonprofit hospitals that need every penny they can get.”

He and other clinicians said their colleagues were sometimes placed in windowless rooms to do administrative work and competed for clients with clinic staff or their fellow service corps members for patients.

“I was not hitting the 20 hours of clinical time a week. That’s what you need for three years to reach the 2,000 hours,” said another clinician. “The problem was there was two of us, so we were sharing patients and basically competing for patients to get these hours.”

Senior leadership at the Mental Health Service Corps “would often make the clinician [feel] responsible, that somehow they were not presenting themselves properly or speaking up enough to get the referrals,” said another.

Some clinicians who spoke with POLITICO expressed concern that their hours would not count toward licensure.

“I don’t know if MHSC took care of the paperwork,” a social worker said. “And my MHSC clinical social worker that was supervising me, she left before I did. If they put her on the paperwork, am I still going to get credit for those hours? … It was eight months of hours I’m not sure count or not.”

It takes 36 months of supervised experience and clinical examination to receive a New York State clinical license for social workers, according to the state education department.

The first group of Mental Health Service Corps clinicians are due to submit their hours to the state education department this spring. So far, no applicants have been evaluated from the Mental Health Service Corps for clinic licensure, according to the state education department. City Hall said it is not aware of any hours for clinicians not counting toward their certification and said it would work with program participants to get their hours counted.

Clinical hours weren’t the only reporting issues.

The Mental Health Service Corps program did not offer consent forms in languages other than English until January 2018 — isolating much of the population the city was aiming to serve.

It also did not indicate that the clinicians will track the patient’s progress and record it for the city to use. City Hall denied that it collects personal data, but said any information that comes to the city is removed of any identifiers, like a patient’s name.

“Patient data allows us to understand patient-level outcomes as one way to monitor the program,” said City Hall spokesperson Marcy Miranda.

Clinicians were given different methods to track data, so the information lacked uniformity. Since then, the program has adopted a more standardized collection method, City Hall said.

The program has served 53,610 individuals as of March 22, city officials said, and provided 261,919 hours of "direct behavioral health services."

Thrive metrics obtained by POLITICO do not show the average number of sessions each patient received or any outcomes related to increasing access to mental health care — an overall criticism of how the city measures and tracks Thrive initiatives.

With the new reporting processes beginning to take effect, former service corps members said they felt disheartened by all the organizational mistakes that may have rendered their work fruitless or alienating to the people it aimed to help.

“I don’t know what my impact was or what my impact could have been,” a social worker said.

The city is no longer hiring participants in cohorts, but rather as individuals, to join the program. There are 278 clinicians in the program as of April 4 — 69.5 percent of maximum capacity, despite McCray envisioning 400 members providing 400,000 hours of care a year.

Still, the city has allocated $45.6 million for the program in the 2020 fiscal year and another $43.8 million in the following year, assuming it can hire more clinicians.

“It seemed as though what we had thought the program was, what we had signed up for, seemed like it could be really strong,” a social worker said. “It could have had the potential to be an example worldwide on what competent mental health care could look like, and what accessible mental health care could look like. It seems to be falling pretty short.”